Genital prolapse is abnormal migration of one or more pelvic organs modifying the form of the vaginal walls and can lead to their exteriorisation through the urogenital orifice. The bladder, uterus and rectum are the main organs relating to this exteriorisation. These organs respectively relate to cystocele, hysterocele and rectocele. Prolapse can also relate to the vaginal fornix in the presence of a hysterectomy, Douglas' cul-de-sac (elytrocele) or associated with intestinal loops (enterocele).
There is a large variety of surgical techniques for correcting vaginal prolapse.
Surgical approaches are sufficiently varied and consist of placing a textile structure at the level of the pelvic floor. The placement of this structure textile can be done vaginally, abdominally or via laparoscopy.
A first technique is the sacrocolpopexy procedure via invasive abdominal method. It comprises suspending the neck of the uterus, the vaginal fornix, or the uterine isthmus, to the anterior longitudinal ligament in front of the promontory, at the junction of the L5-S1 vertebrae, by means of two anterior and posterior prostheses. It can be associated with complementary surgical procedures such as hysterectomy or douglassectomy, for example.
The second technique so-called “without tension” consists of interposing a knitted prosthesis based on monofilament threads made of polypropylene between the bladder and the vagina for a cystocele or between the rectum and the vagina in the case of a rectocele.
The aim of surgical treatment is to replace the suspension means (fascias, ligaments) or the retaining means (muscles of the perineum) which have failed, and most often both of them. These days, synthetic knitted “prostheses” are used. These prostheses serve to replace the failing fascias, or suspend the “fallen” organs with solid natural ligaments. This treatment can be done according to three different surgical methods:                by opening the abdomen (“laparotomy”);        by celioscopy (“laparoscopy”);        by entering via the vagina (“vaginally”).        
The efficacy of the three surgical methods in the hands of an experienced surgeon is the same. Technical simplicity, lowest complication rate, and shortest length of intervention will make the vaginal method for women in menopause or in pre-menopause, the most preferred for many surgical procedures. Celioscopy or laparotomy are plus often reserved for younger women, due to greater long-term efficacy and better resistance to substantial physical forces.
The vaginal transobturator route technique is described in patents WO 2007/016698 and WO 2005/122721. It requires the use of prosthesis of flat shape fitted with arms. The flat part is interposed between the prolapsed organ and the vagina while the arms of the prosthesis pass through the obturating holes of the pelvis. To place the prosthesis in this configuration, the surgeon uses curved or helicoidal needles, commonly known as instruments. These needles perforate the obturating holes of the exterior of the body towards the interior by passing through the skin and exiting in the anterior part of the vagina and determine the passage according to which the implant must be arranged. The arms of the prosthesis are then fixed on the tip of the needle by fastening means. The needle is then moved in the reverse direction to its passage of introduction to place the arms in the obturating holes of the pelvis, and is then withdrawn. The fastening means are also removed so that just the implant remains in the organism.
Document EP 1.399.088 B1 describes succinctly in FIGS. 7f and 7g fastening means between the needle of the instrument and an implant for treatment of prolapse of the pelvic floor. These fastening means can be a single or double knot forming an attachment loop capable of cooperating with a groove made on the distal end of the needle of the instrument, and also attached to the implant. This attachment loop does not ensure a reliable and durable bond between the needle and the implant. The loop is simply gripped manually by the surgeon, making it impossible to control the effort needed for tightening of the loop on the distal end of the needle of the instrument. This tightening effort depends on the surgeon and is therefore random and not reproducible. Also, even if the surgeon applies adequate tightening effort on the loop, it has been observed that these fastening means will relax by sliding of the threads of the loop as the needle moves into the obturating holes or the tissue. It has been observed that the loop formed relaxes as the needle is being withdrawn and causes loss of the implant to be placed; this is prohibitive for this technique, consisting of moving the implant under tension with the fastening means attached to the distal end of the needle blind in tissue or transobturating holes.